Columbus Dentist answers you dental insurance questions:

Dental insurance isn’t really insurance (a payment to cover the cost of a catastrophic loss) at all.  It is actually a money benefit, typically provided by an employer; to help employees pay for routine dental care.  The employer usually buys a plan from an insurance company based on the amount of the money benefit and how much the premium costs per month. And the premium for dental coverage is a fraction of the cost of the premium for medical coverage and with all things in life, you get what you pay for.  And as you know,  there are many Columbus based businesses that invest in decent dental benefit plans for their employees and others that tend to skimp there.

The majority of dental benefit plans are only designed to cover a portion of the total cost of a person’s necessary dental needs.  For example, a dentist may recommend a crown for a tooth that has extensive decay, however, the dental plan may only cover the cost of a filling.  This does not mean that the patient does not need a crown, only that the benefit is limited to a filling.

While a twice yearly insurance payment toward the cost of teeth cleaning is common, that type of payment arrangement actually has no relationship to what any patient might really need. It’s just how their dental benefits plan was setup.

Many patients need cleanings more frequently.  People who have heavy plaque, lots of calculus buildup, or gum disease are prime candidates.  Also, people who are generally healthy but have certain types of systemic conditions, such as diabetes, or those taking specific medications, may require more frequent cleanings.

The good news is that with the help of your dental benefits, the amount you have to pay is reduced!  If you are looking for a new Columbus dentist, give Beth a call at 614-486-7378 and she can answer all your questions.  Or request an appointment online.

 It is exciting when you get that dental insurance benefit-you just know that now you can get that smile you have always wanted.

Dental insurance may have been one reason you chose one job over another. It is a job perk that some receive as an addendum to their medical insurance or a separate negotiated benefit. Unfortunately we aren’t always aware of how the insurance plans work.

 I saw a patient this week that was new to our practice and just received new insurance and was under the impression that he had great coverage. When we went over his treatment plan he couldn’t believe that they only covered a very small percentage of his dental work. He had no idea how the plan worked. 

Each plan and it’s coverage varies according to the contracts between the employer and the insurance company. Some tips on getting to know your insurance plan are to know…

• who controls your treatment- you and your dentist or the insurance company? Some plans may require the dentist to use the “least expensive alternative”.
• Ask to what extent does your insurance cover? Some companies limit your plan to what you can have done.
• Ask what your dental plan covers for prevenative, basic and major work? 
• What is your share for these procedures?
• Ask if there are any limitations on your plan?
• Ask if you are free to see any dentist that you choose? Some companies have a list of Dr.’s that you must see or you don’t have any coverage.

 Whether you have dental insurance or not don’t let the insurance dictate the level of care you want. Find a dentist that will treat you like they would their own family. Hopefully this will help anyone that is looking into dental insurance.

Preferred Provider is a term used by the Insurance Industry to make it sound like these doctors/dentist are “better” than others.  Makes it seem that perhaps your Insurance company has graded the dentist in some way to prefer them over all the other dentists in the area.

In reality, a “Preferred Provider” to a dental insurance company is a dentist that has agreed to take reduced fees in order to be on a list.  And remember that no dentist goes on a list to make less money.  It means they need more patients and they will reduce their fees to get them.

So, how do they make up for the reduced fees?  One way is double booking appointments so they can see more patients in the same day and make up for what they are reducing in thier fees.  What does double booking appointments mean to you?  A long wait in the reception area, in the dental chair, and being rushed through your appoinment just to start with.

Dental Insurance is different than Medical Insurance - In many ways, too many to put in the blog post.  But here are the highlights

• 9 out of 10 medical doctors are on an Insurance preferred provider list
• 2 out of 10 dentists are on an Insurance preferred provider list
• Medical Insurance Lifetime maximum coverage per patient can be 1 million dollars
• Dental Insurance Annual maximum coverage per patient ranges from $800 – $1500 per year.  That would be a lot of years before it reached a million.
• Medical Insurance monthly premium fee is hundreds of dollars
• Dental Insurance monthly premium fee is $10 for a family of 4

So when you decide to chose a dentist because your insurance provider has them on a list, think about this:   Did you spend more time chosing where you are going for lunch?

It’s open enrollment time of year……

It’s that time of year again when patients begin asking which plan they should choose during their employers open enrollment period.  So we thought we would define the different flavors of dental benefit plans out there.

There are probably 50 to 100 different dental benefits providers in the Columbus Ohio area.  And within those plans there are even more different flavors of the plans that were negotiated between your employer and the Insurance company.   A Metlife plan at company A isn’t the same plan as the Metlife Plan at company B.

Dental Plans typically fall into these catagories.  If you are having difficulties figuring out your plan choices, fax us(486-2608) a copy of the pages from your benefits handbook.  

PPO Plans

• You are free to choose any dentist 
• If you choose a dentist from a list, the patient is given financial incentives.  How great are the financial incentives?  That’s hard to determine without a defined fee schedule from your plan.  In our office we’ve seen the difference in cost for a cleaning be nothing.  On average the difference is between $5 and $15 per cleaning. 
• Think about this: Does choosing a dentist on the list save me money, or my insurance company money?
• The PPO Plan pays all or part of the dentist’s fee to the extent that it does not exceed the UCR fee for that service.  How insurance companies calculate the UCR fee

DPO or DMOs

• Under these plans you must choose a dentist from a list to receive any benefit.
• If you do not choose a dentist on the list the entire cost of the dental visit will be your responsibility

My plan says I will be covered up to 80% or up to 100% so I’ve got a great plan, right?

Many plans tell their participants that they will be covered “up to 80% or up to 100%” but do not clearly specify the plan UCR fee schedule, allowance, annual maximum or limitations.  The UCR fee schedule is what they will pay 80% of, not the fee your dentist charges.  (See post on how insurance companies calculate the UCR fee) 

By the way, your dental office has no idea what the UCR fee schedule is for your particular plan with your insurance company.   We don’t know for certain what your insurance company will pay until we receive the claim back.  Based on our experience, it is realistic to expect dental insurance to cover about 50% for major restorative services like crowns, large fillings, and root canals. 

The good news is that most dental benefit plans pay the majority of the fee for your dental maintenance such as cleanings and xrays.  And coming in for professional dental cleanings on a regular basis can help us keep small problems from becoming major restorative stuff.

So which should you cho0se if you are a Grandview Dental Care Patient? 

You need to decide what dental plan to choose based on your needs.  If you choose a plan where you are allowed to choose any dentist(typically a PPO) you will receive dental benefits to help you pay for the cost of the dental work you have done.

Cigna, Metlife, Anthem, UHC, etc, as long as you can choose any dentist, you will have a certain level of coverage from the insurance company and a certain level of out-of-pocket depending on your plans fee schedule.  Remember, you get what you pay for.  If you pay $10 per month for dental coverage for your entire family, you are going to have some out-of-pocket expense for your dental care.

What does UCR fee stand for?

Well… the letters in UCR stand for Usual, Customary, and Reasonable.  Almost sounds like the Insurance company is doing extensive surveys of dental fees in your zip code and then taking the average, say 70% – 75%,  fee.  But guess what, that is not what the Insurance company does.

Insurance companies  calculate the UCR in differing ways, but it’s usually between the 50th and 80th percentile of what fees are in a geographical area.  The geographical area is not limited to a certain radius around a certain zip code.  It can include an entire state and includes all the rural, urban, and suburban dentists and we all know that location can effect the price for good and services. 

The UCR fee guide generated by the insurance company is a price they will allow for every dental procedure they cover.  This is not based on what a dentist actually charges, but what the dental insurance wishes to cover for the premium your employer wants to pay. 

And to further complicate things the Insurance company typically only covers 80% of their UCR fee, so dental benefits were meant to have some patient out-of-pocket expense. 

It’s amazing that the UCR fee varies between insurance companies and even between different plans in the same company. 

This is because dental benefits and the associated UCR fee schedule are determine by the negotiations between the insurance company and your employer.  And the better the dental benefits the plan offers the more you and your employer pay in the premiums to the insurance company.  Your employer has likely selected a UCR fee schedule that corresponds to the premium cost they desire.

So the adage… you get what you pay for…. is alive and well with dental insurance.  

So if my out of pocket is less if I go to a dentist on a list, why wouldn’t I just go to a dentist on a list to save money.

Whew that was a long headline!  Do you make all of your buying decisions based on cost?  Do you buy the cheapest car?  The cheapest television?  Go to the least expensive place to eat every time you go out? 

A dentist on an insurance list has agreed to cut their fees in order to get on the list.  They typically get on the list because they need new patients.  Ask yourself, why do they need new patients?  We get 85% of our new patients based on referrals from existing patients.  Current patients send their friends and family to us because they trust us and appreciate what we do for them.  This is a big compliment to us!

When a dentist is on a list what expenses are they cutting to keep their bottom line the same?

A dentist sets their fees in order to meet their business expenses, office building, employee costs, lab costs, dental supply costs, electric, continuing education, better equipment etc.  If a dentist has to cut their fees to be on a list how do they make up those costs? 

Think about it.  A dentist is not going to participate on a list in order to take home less so they need to cut costs somewhere…. but where are they cutting costs and are you ok with going to dentist that cuts costs in these areas?

Instead they are cutting costs in other areas that can effect your experience as a patient and even the quality of the work done in your mouth.  

• Because they need to see more patients, the doctor can not take the time off to take continuing education classes that help them get better at what they do or learn a new technique which makes things more comfortable for you the patient. 
• They may use inferior dental materials that are cheaper and don’t last as long.
• They may use a lower quality dental lab because the cost is lower. 
• They may not pay their employees very well so they don’t attract and keep the best employees.  It’s comforting to see the same hygienist at each cleaning or talk to the same dental assistant that asks about your kids and knows you like nitrous oxide or have a latex allergy and to be greeted when you walk in the front door by someone you know.  
• Many times it effects your wallet because they overbook their schedule because they have to see more patients which means you are stuck waiting in the waiting room.  Time is money ya know.
• Or perhaps you are rushed through your appointment because patients are backed up in the waiting room.

So, the money question.  Does choosing a dentist on a list save me money or my insurance company money?

Consider this:  In 2007 we were a participating provider with a big name insurance company that happens to use a cartoon character in a lot of their advertising. 

• We had patients that participated in this plan and came to see us “out-of-network” prior to 2007. 
• Prior to 2007 some of these patients that came to see us “out-of-network” their out-of-pocket on their cleaning was 50¢. 
• The insurance company paid our fee for a cleaning except for 50¢
• When these same patients came in for their cleaning in 2007 our fee for a cleaning hadn’t changed.
• Because we were a provider on the list and had contracted to take reduced fees, the insurance company only paid 66% of our fee for a cleaning which saved the insurance company over $22.
• So the insurance company saved $22, the patient saved 50¢!
• No wonder the insurance company wants you to go to a provider on their list.  It’s better for them but is it better for you?  Only you can decide that.

By the way, We got off the list in late 2007 because we were unwilling to shortcut the way we treat and care for our patients.